Page 3 - World Journal of Laparoscopic Surgery

WJOLS
WJOLS

10.5005/jp-journals-10033-1227
Two Port Laparoscopic Cholecystectomy: An Initial Experience of 25 Cases with a New Technique
OriginaL articLe

Two Port Laparoscopic Cholecystectomy: An Initial

Experience of 25 Cases with a New Technique

2
1 Aswini Kumar Misro, Prakash Sapkota

ABSTRACT 11 mm epigastric wounds land up in a dimension of 13
Background: In Nepal, it is quite common to find patients with to 14 mm or more at times at the completion of the pro-
large stone burden and thick gallbladder wall which often leads cedure. However, we have used this wound extension
to incision extension. We have used this extended incision to to our advantage by introducing another 5 mm port
our advantage. The present technique of two port laparoscopic
cholecystectomy not only helps overcoming the specimen through the epigastric wound from the outset. This not
extraction difficulties but also contributes to better cosmesis. only obviates the need for any additional port insertion
Patients and methods: A total of 25 patients underwent the but also aids in specimen extraction. This forms the
surgery in 2008 to 2010. rationale behind two port laparoscopic cholecystectomy.
Results: The mean operating time was 50 minutes. None With the technique described in this article, one will
had significant procedural blood loss, iatrogenic injury, per- be able to perform laparoscopic cholecystectomy with
foration of gallbladder, bile spillage, significant gas leak or
subcutaneous emphysema at either port site. All patients were only 2 incisions leading to a more cosmetic scar and less
t
comfor able in the postoperative period and were routinely postoperative pain. Last decade has seen many innova-
discharged on 2nd postoperative day except for two patients tions like SILS, NOTES from healthcare industries driven
who has surgical site infection and fever respectively. Although
three cases were converted to standard 4 port technique, by an ever increasing demand for cosmesis. However, the
none required conversion to open cholecystectomy. Out of cost factor keeps them out of the reach of a common man
25 patients, 7 cases have completed 3 months follow-up and in developing countries. This technique certainly adds
did not show any complication like port site hernia. to cosmesis still fitting to the budget of a common man.
Conclusion: The described method of performing two port
laparoscopic cholecystectomy is safe, simple and inexpensive PATIENTS ANd METhodS
yet cosmetically rewarding.
Keywords: Laparoscopy, Gallbladder, Cholecystectomy, Port. Twenty-five patients underwent the operation in 2008
How to cite this article: Misro AK, Sapkota P. Two Port Laparo- to 2010 after the hospital ethical committee approval.
s copic Cholecystectomy: An Initial Experience of 25 Cases with Informed consent was obtained from all the patients.
a New Technique. World J Lap Surg 2014;7(3):103-106.
All the surgeries were performed by the same team of
Source of support: Nil
surgeons. Every single patient had investigation proven
Conflict of interest: None gall stone or related complications. Operative time, hospital
stay and complications were recorded in each case.
BACKgRouNd The patient characteristics are mentioned below.
In Nepal, it is quite common to find patients with large There were 10 males and 15 females patients and none of
stone burden and thick gallbladder wall which often the patients had any abdominal surgery in the past. The
leads to specimen extraction difficulties. Out of all the mean age was 40.5 years (27-55 years). All the patients
available methods to facilitate the extraction like fascial had BMI below 30.14 patients were ASA I and 11 were
dilatation, stone crushing, ultrasonic high-speed rotary, ASA II (8 patients were controlled hypertensives and
or laser lithotripsy, we prefer to use incision extension 3 were controlled diabetics).
since it has been described as the optimal method and oPERATIvE TEChNIquE
1
does not aggravate postoperative pain. Many of the
Peritoneal entry is done by open technique with insertion
of a 10 mm port through the umbilicus. After creating
1 Assistant Professor, Lecturer pneumoperitonium, a 1 cm transverse skin incision is
2
1,2 Department of Surgery, Lumbini Medical College and taken in the midline at a level 1 inch cephalad to the
Research Center, Palpa, Nepal level of inferior border of liver for the epigastric port. A
Corresponding Author: Aswini Kumar Misro, Assistant 10 mm port is inserted through the later incision verti-
Professor, Department of Surgery, Lumbini Medical College cally till it pierces the rectus sheath (This will be referred
and Research Center, Palpa, Nepal, Phone: 00-97775-691344 henceforth as port 2). Afterwards, a slight right side
e-mail: draswini@gmail.com
angling of the port is done to bring it through the angle
World Journal of Laparoscopic Surgery, September-December 2014;7(3):103-106 103